TATALAKSANA

RINOSINUSITIS DI
LAYANAN PRIMER

Dr. Sinta Sari Ratunanda, M.Kes, SpTHT-KL(K)

Bandung - 2018
 TUJUAN

– Latar Belakang
– Definisi dan Klasifikasi Rinosinusitis
– Diagnosis Rinosinusitis
– Tatalaksana Rinosinusitis
– Tatalaksana Rinosinusitis Akut
– Tatalaksana Rinosinusitis Kronis
– Peranan Nasal Dekongestan
LATAR BELAKANG
 Epidemiologi >>
RSHS, 2008 : 75 % Rhinosinusitis

USA 2005 :
135 : 1000 populasi

Europe 2005 :
10%-30% adult
40% children

James A.Hadley,Mani S.Kavuru,Jack B.Anon,Lily C.Pien,Diagnosis and Management Rhinitis and Rhinosinusitiis,Third edition,2005
 DEFINISI

RINOSINUSITIS:
Inflamasi mukosa sinonasal yang ditandai oleh ≥ 2 gejala :
- Salah satunya harus : Hidung tersumbat atau hidung beringus
- Nyeri pada wajah/kepala
- Gangguan penciuman / BATUK
 Definisi…

disertai gambaran Nasoendoskopi :

- Sekret dari ostium sinus, atau
- Kongesti hidung, atau
- Polip

dan/atau : Penebalan mukosa pada CT Scan

Klasifikasi

RINOSINUSITIS

AKUT < 12 MINGGU KRONIK > 12 MINGGU

TANPA DISERTAI
POLIP POLIP
DIAGNOSIS..

ANAMNESIS

PEMERIKSAAN FISIK

PEMERIKSAAN PENUNJANG
ANAMNESIS……..

HIDUNG MELER/PILEK NYERI GANGGUAN

TERSUMBAT WAJAH/SEKITAR PENCIUMAN/
NYA BATUK
TATALAKSANA
RINOSINUSITIS
 Tatalaksana Rinosinusitis

– MEDIKAMENTOSA

– TINDAKAN/OPERATIF
apabila medikamentosa
gagal/komplikasi:
BEDAH SINUS ENDOSKOPIK
MEDIKAMENTOSA

Pemberian medikamentosa pada Rinosinusitis meliputi :

– Nasal irigasi/cuci hidung menggunakan larutan NaCl fisiologis (setara)
– Pemberian antibiotika sesuai indikasi
– Kortikosteroid intranasal
– Terapi suportif /simptomatik
– Terapi untuk faktor predisposisi Rinosinusitis (pada rinosinusitis kronik
terutama).
 Tatalaksana
RINOSINUSITIS AKUT

CUCI HIDUNG NASAL SIMPTOMATIK ANTIBIOTIK

KORTIKOSTEROID
TATALAKSANA RINOSINUSITIS
AKUT
VIRAL RHINOSINUSITIS….
Tatalaksana: Suportif - Simptomatik

Rinosinusitis akut viral (Acute Viral Rhinosinusitis/common cold)

ditandai dengan tanda dan gejala dari rinosinusitis akut, yang
disebabkan oleh infeksi virus , dengan gejala dan tanda dapat
berlangsung kurang dari 5 hari – 10 hari dan gejala membaik.
Apabila gejala menetap lebih dari 10 hari (tetapi tidak ada
perburukan gejala), hal ini disebut Postviral Acute Rhinosinusitis
Tatalaksana
Rinosinusitis Akut Viral

Terapi tambahan/ suportif:

– Dekongestan
– anti histamin
– analgetik & antipiretik
– Kortikosteroid topikal
– cuci hidung larutan garam fisiologis
– mukolitik
– herbal
Pemberian Antibiotik:
Rinosinusitis Akut Bakterialis

Rinosinusitis akut disebut Rinosinusitis Akut Bakterialis bila memenuhi 3 dari 5

kriteria di bawah ini :
– 1. Hidung beringus berwarna/sekret hidung mukopurulen(terutama unilateral)
– 2. Nyeri berat di wajah/pipi/dahi(terutama unilateral)
– 3. Demam (lebih dari 38º)
– 4. Meningkatnya Laju Endap Darah atau CRP (C-Reactive Protein)
– 5. Double sickening (gejalanya menjadi berat kembali setelah ada sempat
perbaikan awal)
Pemberian antibiotik:
Rinosinusitis Akut Bakterialis

– Antibiotik Lini I (amoksisilin +

klavulanat)/eritromisin) observasi selama 3 – 5 hari.
Bila perbaikan kurang, berikan :
– Antibiotik Lini II golongan : sefalosporin, kuinolon,
makrolid
Tatalaksana
Rinosinusitis Akut Bakterialis
Terapi suportif :
– cuci hidung larutan garam fisiologis
– anti histamin,
– analgetik & antipiretik
– kortikosteroid topikal
– dekongestan
– mukolitik
– herbal
Bailey Byron J.and Jonas T. Johnson. Head and Neck Surgery – Otolaryngology, 5th
th edition. Volume 1.

Philadelphia: Lippincot, William and Wilkins, 2014.

Tatalaksana
RINOSINUSITIS KRONIS

– Kortikosteroid merupakan terapi medikamentosa lini pertama pada

rinosinusitis kronis (Kortikosteroid topikal/Kortikosteroid sistemik)
– Antibiotik???? (ya pada eksaserbasi akut)
– Cuci hidung larutan garam fisiologis
– Antihistamin: Diberikan hanya pada pasien dengan rinitis alergi
– Terapi suportif dan terapi predisposisi Rinosinusitis kronik
sana
Rinosinusitis Kronis
 SURVEY

Passali D, Cingi C, Cambi J, Passali F, Muluk N, Bellussi M. A survey on chronic rhinosinusitis: opinions from experts
of 50 countries. European Archives Of Oto-Rhino-Laryngology [serial on the Internet]. (2016, Aug)

- CRS patients were principally treated by

otorhinolaryngologists (70 %).
- Medical treatments included nasal corticosteroids (90 %),
nasal washes (68 %), and nasal decongestants (32 %).
- In 88 % of countries, more than 50 %, or 'about 50 %', of all
patients reported subjective symptom improvement after
treatment.
Peranan Oksimetazolin dalam Tata
Laksana Kongesti Hidung
 Classification of Nasal Decongestants
selective α1 Selective α2 α-Adrenergic
agonist agonist Agonist

Phenylephrine Naphazoline Pseudoephedrine

Phenylpropanolamine
Oxymetazoline Xylometazoline

Oxymetazoline

1
Tripathi KD. Essentials of Medical Pharmacology. New Delhi: Jaypee Brothers Medical Publishers;c2013:125-
137
 Overview of Nasal Decongestants
Naphazoline Xylometazoline Oxymetazoline Pseudoephedrine Phenylpropanolamine

Mode of Selective α2 agonist) Selective α2 agonist) Selective α2 Alpha-Adrenergic Directly stimulate

action agonist) Agonist. adrenergic receptors but
probably indirectly
stimulates both α- and β-
adrenergic receptors

Duration of Longer duration of Longer duration of Long duration of

action action (12 hours) action (10 hours)2 action (12 hours)

Dose 0.1% topical in nose 0.05–0.1% topical in 0.025–0.05% 30- 60 mg three 25–50 mg daily
nose topical in nose times a day

Adverse Impairs mucosal ciliary Impairs mucosal Impairs mucosal Rise in BP can occur, Rise in BP
effects function causing ciliary function ciliary function especially in
Atrophic rhinitis and causing Atrophic causing Atrophic hypertensive, CNS
anosmia, CNS rhinitis and anosmia, rhinitis and effects
depression and rise in CNS depression and anosmia, CNS
BP, initial stinging rise in BP depression and
sensation rise in BP

1
Tripathi KD. Essentials of Medical Pharmacology. New Delhi:Jaypee Brothers Medical Publishers;c2013:125-137. 2 SUDAFED 0.1%
NASAL SPRAY. MHRA. http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con152860.pdf. Accessed September
18.09.2015
 Oxymetazoline-Structure and
Mechanism of action
Mechanism of Action 2
• Oxymetazoline is a direct
acting sympathomimetic
amine
• Acts on alpha-adrenergic
Imidazole derivative with direct acting receptors in the arterioles
sympathomimetic activity1 of the conjunctiva and
Chemical Name - 6-tert-butyl-3-(4,5- nasal mucosa
dihydro-1H-imidazol-2-ylmethyl)-2,4- • In nasal it produces
dimethylphenol constriction, resulting in
Molecular Formula - C16H24N2O decreased blood flow and
decreased nasal congestion
Molecular weight - 260.37456 g/mol
1
Oxymetazoline. PubChem.
https://pubchem.ncbi.nlm.nih.gov/compound/oxymetazoline#section=Top. Accessed.
August 18,2015.
2
Oxymetazoline. DrugBank. http://www.drugbank.ca/drugs/DB00935. Accessed. August
Summary of Triple Action of
Oxymetazolin
Pharmacodynamic   Scientific Clinical Effect on
Properties of Evidence benefit Course of
Oxymetazoline disease

Antiviral Inhibitis the activity

of HRV 14,
Causal
Effect
In vitro Studies
1,2
Fights the
viruses that
faster and
stronger
downregulates virus cause rhinitis improvement of
receptor ICAM-1 symptoms like
sneezing,
rhinorrhea,
nasal
obstruction,
impaired taste
Antioxidat Inhibits pro-
inflammatory
Pathogenetic
Effect
In vitro Study 3 Inhibits rhinitis
symptoms
and smell and
general well-
ive/ pathways,
being +
suppresses oxidative
Anti- stress
Shortens the
duration of cold
inflammat from 6 to 4
days
ory
Vasocons de-swelling of nasal
mucosa
Symptomatic
Effect
Clinical Study 4 Decongestion
of the nose,
trictive easy Clinical Study 5
breathing and (vs. Saline solution)
outflow of
1)Sacher et al., 2005 Antiviral Properties of Oxymetazolin, DAZ, No. 5: 111-112 Glatthaar-Saalmueller B et al. 2005. Oxymetazoline exerts
secretion
antiviral activity against human rhinovirus-14 and downregulates expression of ist receptor ICAM-1 on human umbilical vein and
endothelial cells.
germs
OEGAI Annual Meeting, Graz/Austria, December 01-03: P51. 3)Beck-Speier et al., 2006, Oxymetazoline Inhibits Proinflammatory
Reactions: Effects on Arachidonic Acid-Derived Metabolites, JPET 316: 843-851. Westerveld et al,1995, Anti-oxidant actions of
oxymethazoline an xylomethazoline, Eur J Clin Pharmacol 291: 27-31 Connell JT., 1969, Effectiveness of topical nasal decongestants.
Annals of Allergy 27: 541-546 Reinecke S. & Tschaikin M., 2005, Investigation of the effect of oxymetazoline on the duration of rhinitis.
Results of a placebo-controlled double-blind study in patients with acute rhinitis. MMW Fortschr Med 147 Suppl 3:113-118
 Indikasi Oksimetazolin

– Rinitis Alergi
– Rinitis Non Alergi
– Rinosinusitis Akut dan Kronis
– Rinosinusitis Kronik disertai Polip
Pemberian Oksimetazolin

- Pemakaian Kombinasi dengan Preparat lain

- Lama pemakaian : 3 – 5 hari
- Cara Pemakaian yang benar
- Dosis anak dan dewasa diperhatikan
- Edukasi kepada pasien
Take Home Message

– Pentingnya mengenal pengertian dan klasifikasi

Rinosinusitis  membuat tatalaksana yang sesuai
– Mengenal tatalaksana yang bisa dilaksanakan di layanan
primer
– Mengenal peranan dekongestan dalam tatalaksana
Rinosinusitis
Hatur
Nuhun